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. 2022 Mar;24(2):195-206.
doi: 10.1111/bdi.13119. Epub 2021 Aug 12.

Bipolar symptoms, somatic burden, and functioning in older-age bipolar disorder: Analyses from the Global Aging & Geriatric Experiments in Bipolar Disorder Database project

Martha Sajatovic  1 , Annemiek Dols  2 , Soham Rej  3 , Osvaldo P Almeida  4 , Alexandra J M Beunders  2 , Hilary P Blumberg  5 , Farren B S Briggs  6 , Brent P Forester  7   8 , Regan E Patrick  7 , Orestes V Forlenza  9 , Ariel Gildengers  10 , Esther Jimenez  11 , Eduard Vieta  11 , Benoit Mulsant  12 , Sigfried Schouws  13 , Nadine Paans  14 , Sergio Strejilevich  15 , Ashley Sutherland  16 , Shangying Tsai  17 , Betsy Wilson  18 , Lisa T Eyler  16   19
Affiliations

Bipolar symptoms, somatic burden, and functioning in older-age bipolar disorder: Analyses from the Global Aging & Geriatric Experiments in Bipolar Disorder Database project

Martha Sajatovic et al. Bipolar Disord. 2022 Mar.

Abstract

Objective: Literature on older-age bipolar disorder (OABD) is limited. This first-ever analysis of the Global Aging & Geriatric Experiments in Bipolar Disorder Database (GAGE-BD) investigated associations among age, BD symptoms, comorbidity, and functioning.

Methods: This analysis used harmonized, baseline, cross-sectional data from 19 international studies (N = 1377). Standardized measures included the Young Mania Rating Scale (YMRS), Hamilton Depression Rating Scale (HAM-D), Montgomery-Asberg Depression Rating Scale (MADRS), and Global Assessment of Functioning (GAF).

Results: Mean sample age was 60.8 years (standard deviation [SD] 12.2 years), 55% female, 72% BD I. Mood symptom severity was low: mean total YMRS score of 4.3 (SD 5.4) and moderate-to-severe depression in only 22%. Controlled for sample effects, both manic and depressive symptom severity appeared lower among older individuals (p's < 0.0001). The negative relationship between older age and symptom severity was similar across sexes, but was stronger among those with lower education levels. GAF was mildly impaired (mean =62.0, SD = 13.3) and somatic burden was high (mean =2.42, SD = 1.97). Comorbidity burden was not associated with GAF. However, higher depressive (p < 0.0001) and manic (p < 0.0001) symptoms were associated with lower GAF, most strongly among older individuals.

Conclusions: Findings suggest an attenuation of BD symptoms in OABD, despite extensive somatic burden. Depressive symptom severity was strongly associated with worse functioning in older individuals, underscoring the need for effective treatments of BD depression in older people. This international collaboration lays a path for the development of a better understanding of aging in BD.

Keywords: aging; bipolar disorder; depression; functioning; mania; medical burden.

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Figures

Figure 1.
Figure 1.
Age distributions for each cohort are shown. Abbreviations in the legend refer to study names as seen in Supplementary Table 1.
Figure 2.
Figure 2.
Scatter plot of the association between age and manic symptom severity, as measured by log YMRS, with best-fitting regression line.
Figure 3.
Figure 3.
Scatter plot of association between age and depressive symptom severity, with best-fitting regression line.
Figure 4.
Figure 4.
Scatter plot of the relationship of mania severity, as measured by log YMRS, to GAF total score.
Figure 5.
Figure 5.
Scatter plot of the relationship of depression severity to GAF total score.
See this image and copyright information in PMC

References

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    1. Sajatovic M, Eyler L, Rej S, et al. The global aging and geriatric experiments in bipolar disorder database (GAGE-BD) project: Understanding older age bipolar disorder by combining multiple datasets. Bipolar disorders 2019. May 13. - PubMed

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